Swallowing Problems

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Swallowing seems simple, but it's actually pretty complicated. It takes your brain, several nerves and muscles, two muscular valves, and an open, unconstricted esophagus, or swallowing tube to work just right.

Your swallowing tract goes from the mouth to the stomach. The act of swallowing normally happens in three phases. In the first phase, food or liquid is contained in the mouth by the tongue and palate (oral cavity). This phase is the only one we can control.

The second phase begins when the brain makes the decision to swallow. At this point, a complex series of reflexes begin. The food is thrust from the oral cavity into the throat (pharynx). At the same time, two other things happen: A muscular valve at the bottom of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airway (trachea) to prevent food from entering the airways. This second phase takes less than half a second.

The third phase starts when food enters the esophagus. The esophagus, which is about nine inches long, is a muscular tube that produces waves of coordinated contractions (peristalsis). As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. The third phase of swallowing takes six to eight seconds to complete.

A wide range of diseases can cause swallowing problems, which your doctor may call "dysphagia." These include:

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How Do I Know If I Have a Swallowing Problem?

Under normal circumstances, people rarely choke during a meal. Occasionally, food will stick in the esophagus for a few seconds (especially solid foods), but will pass spontaneously or can be washed down easily with liquids. But there are a number of symptoms that you should get checked for a possible swallowing problem, including:

Frequent choking on food

Hesitancy in food passage for more than a few seconds

Pain when swallowing

Recurring pneumonia (an indication that food may be going into the lungs rather than the esophagus)

Immediate medical attention is needed when food becomes lodged in the esophagus for more than 15 minutes and doesn't pass spontaneously or with liquids.

Some people don't know that they have swallowing problems, because they compensate unconsciously by choosing foods that are easier to eat, or they eat more slowly. However, untreated swallowing problems raises the risk for choking or having large pieces of solid food lodge in the esophagus.

How Are Swallowing Problems Diagnosed?

If you think you have a swallowing problem, talk to your health care provider. You may get tests such as:

Cineradiography: An imaging test in which a camera is used to film internal body structures. During the test, you will be asked to swallow a barium preparation (liquid or other form that lights up under X-ray). An X-ray machine with videotaping capability will be used to view the barium preparations movement through the esophagus. This is often performed under the guidance of a speech pathologist, an expert in swallowing as well as speech.

Upper endoscopy: A flexible, narrow tube (endoscope) is passed into the esophagus and projects images of the inside of the pharynx and esophagus on a screen for evaluation.

Manometry: This test measures the timing and strength of esophageal contractions and muscular valve relaxation.

Impedance and pH test: This test can determine if acid reflux is causing a swallowing problem.

How Are Swallowing Problems Treated?

Treatment depends on the type of swallowing problem you have. Sometimes, a swallowing problem will resolve itself without treatment. On other occasions, swallowing problems can be managed easily. Complex swallowing problems may require treatment by a specialist or several specialists.

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If you have a chewing or swallowing problem there are several things you can do to make eating and drinking easier and safer, including:

Positioning

Sit upright at a 90-degree angle.

Tilt your head slightly forward.

Remain sitting upright or standing for 15 to 20 minutes after eating a meal.

Periodically suck on Popsicles, ice chips or lemon ice, or drink lemon-flavored water to increase saliva production, which will increase swallowing frequency.

Food consistency

Minimize or eliminate foods that are tough to chew and eat more soft foods.

Puree food in a blender.

If thin liquids cause you to cough, thicken them with a liquid thickener (your speech pathologist can recommend one for you). You can also substitute thicker liquids for thin ones, such as nectar for juice and cream soup for plain broth.